HomeMy WebLinkAboutCLE201500057 Application 2015-04-09Application for Zoning Clearance
CLE # ZUI5'
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OFFICE USE 01V Y 3
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PLEASE REVIEW ALL 3 SHEETS
Check # Date:
Receipt # 1 Staff:
PARCEL INFORMATION qqw, INA
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Tax Map and Parcel: W 1 11- i Existing Zoning 1 1!V
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Parcel Owner: okt)t'Yln �0.1�� ��%P 1 U
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Parcel Address:agoZ ►c��Qi_,iG q' '
(include suite or floor)
PRIMARY CONTACT
Who should we call/write concerning this project?
Address n x 0yi P City hf�((G N r �� State Zip
: a( 1-5 --
Office Phone: ( Q-1 i Cell #€'16 Fax # E-mail V Tllt f3r_A �J � al I
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APPLICANT INFORMATION
Check any that apply: Change of ownership Change of use Change of name New business
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Business Name/Type: �,~��7��'��i � '�r14� ��
Previous Business on this site��4iS'
Xess
Describe the proposed businincluding use, number of employees, number of shifts, available parking spaces, number of
vehicles, and any additional information that you can provide:
*This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided
knowledge.. I have read the conditions of approval, and I understand them, and that I will abide by them.
is true and accurate the best of
x,
Signature Printed C�S�Vi1
APPROVAL INFORMATION Denied
[ ]
] Approved as proposed [ ] Approved with conditions
[ ] Backflow prevention device and/or current test data needed for this site. Contact ACSA, 977-4511, x117,
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
/
Building Official Date
I
l 1
Date
Zoning Official
j
Date
Other Official
County of Albemarle Department.of Community Development
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296-5832 Fax: (434) 972-4126
Revised 7/1/2011 Page 2 of 3
/
Intake to complete the following:
Y /O
Is use in LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /
Willt ere be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well oru=,,-
a r?
If private well, provide Healthment form.
Zoning review can not.begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or lic sew .
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
Reviewer to complete the following:
Square footage of Use: /7 OD
6)/N
Permitted as: V4. l^ nl 1 )'�
Under Section: Zy 2- Cyd
Supplementary regulations section:
Parking formula: 2 �raSs Q✓�cl�cjiv�% d ��'� A-D�
Required spaces:
P? 4Wij
Y/K—)
Items to be verified in the field:
Inspector ; Date:
Notes:
Zoning to com Tete the following:
Violations: Proff
Y/J Y/
If so, ist: If so, List:
Variance: s'
6/N /N
If so, List:
If so, List: $
gy�2� 9- - z
9 9 - S3
Clearances: SDP's
Revised 7/1/2011 Page 3 of 3
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